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Mild Back Pain: Advice as Good as Therapy

Do-It-Yourself Treatment Provides Same Results as Physical Therapy in Minor Cases
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WebMD Health News

Sept. 23, 2004 -- Routine physical therapy is no better at relieving mild to moderate back pain than good advice from a therapist on how to remain active, a new study shows.

"Remain as active as possible and take up some form of regular exercise, such as walking or swimming," says study researcher and physiotherapist Helen Frost, MSCP, MSc, of the University of Warwick in the U.K.

Her study showed that people with mild to moderate back pain fared no better after getting up to six professional physical therapy sessions than those who met only once with a therapist and were told what to do. Low back pain is one of the most frequent problems seen by health care providers, an estimated four in five Americans will be affected will lower back pain at some point in their lives.

Each of the 286 patients she tracked -- all with back pain for at least six weeks and most with a history of problems -- had an initial counseling session and were given an instruction book written by physical therapists on how to cope with their pain.

After that, half continued to get personalized and supervised exercise and manual manipulation by a trained physiotherapist, the term for physical therapists in the U.K., and elsewhere. The others got no additional treatment from the therapists.

Everyday Exercise Best

A disability score and ease of movement was assessed every few months for one year; the participants were also asked about their perceived benefit from the treatment. Throughout the year, both groups had similar levels of relief.

Does this surprise Frost, a physical therapist herself?

"Not entirely," she tells WebMD. "The back book that all the patients were given has previously been shown to be effective. It encourages patients to remain as active as possible. They were not taught any specific exercises, only advised to remain active and get regular exercise."

A likely explanation: The type of mild to moderate back pain in Frost's patients, which affects most Americans, usually resolves itself on its own -- no matter what you do, says James Weinstein, DO, chairman of orthopaedics at Dartmouth Medical School and spokesman for the American Academy of Orthopaedic Surgeons. However, it recurs in about 70% of people.

He also advises staying active with regular aerobic exercise to remove lactic acid and other pain-causing chemicals, and with yoga and other routines that stretch back muscles. "I recommend taking aspirin or an over-the-counter pain reliever before you exercise or lift things, or even have a cup of coffee, to prevent pain you might have had," he says. Caffeine is thought to stop or decrease pain.

Frost acknowledges that despite having ongoing problems, all of the patients in her study had nondebilitating back pain.

"Therefore, they were more likely to cope with good advice given by a physiotherapist, particularly when it's supplemented by the information in the back book." But those with severe pain might fare better with professional physical therapy, she says.

The findings are published in this week's BMJ.

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